Recurrent Third Nerve Paresis with Migraine: A Case Report and Review of the Literature

ABSTRACT

Ophthalmoplegic migraine (OM), first described by Charcot in 1870, is a disorder characterised by recurrent episodes of migraine associated with ophthalmoplegia. It has been extensively described in children and is rarer in adults. Commonly, the third nerve is affected with pupillary involvement and, more rarely, the fourth or the sixth nerve. OM is now believed to be an inflammatory demyelinating neuropathy. However, in the largest series of OM so far, by Lal et al. it most commonly involved the sixth nerve, started with a crescendo migraine and was accompanied by no enhancement of the cranial nerves. This has led to a rethink about the role of migraine, in the pathogenesis of OM. We describe a 14-year-old boy, with a 10-year history of intermittent headache followed by drooping of right eyelid and diplopia. The current episode started with a migrainous headache, which increased in severity over 3 days, followed by right third nerve paresis with pupillary involvement. Contrast-enhanced magnetic resonance imaging (MRI) of the brain with contrast showed nodular thickening at the root entry zone of the right oculomotor nerve with bright enhancement. The child responded to oral prednisolone, which was tapered over a month. Migraine prophylaxis with propranolol was concurrently added. His repeat MRI brain showed complete disappearance of enhancement of the lesion at 1 year.

KEYWORDS:

• Ophthalmoplegia
• migraine
• oculomotor nerve
• ophthalmoplegic migraine
• magnetic resonance imaging

Acknowledgment

This is to certify that this work is the authors’ original work and has not been published elsewhere. This paper is also not being considered for publication elsewhere. All authors were involved in the care of the patient and also in preparation and revision of the manuscript.

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No potential conflict of interest was reported by the authors.

Ethical statement

The Institutional Ethical Committee waived the need for ethical clearance, as this was a case report with standard of care treatment.

Informed consent

Informed consent was taken from the patient for this study.

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Funding

The authors reported that there was no funding associated with the work featured in this article.